Provider Demographics
NPI:1215010137
Name:WHITE, HANS JURGEN (PA)
Entity Type:Individual
Prefix:
First Name:HANS
Middle Name:JURGEN
Last Name:WHITE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 CLINTON STR.
Mailing Address - Street 2:P.O. BOX 1318
Mailing Address - City:MT. GILEAD
Mailing Address - State:NC
Mailing Address - Zip Code:27306
Mailing Address - Country:US
Mailing Address - Phone:910-439-6406
Mailing Address - Fax:
Practice Address - Street 1:610 N FAYETTEVILLE ST
Practice Address - Street 2:SUTE 103
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-4670
Practice Address - Country:US
Practice Address - Phone:336-625-1285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101248363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
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